Menopause

The cessation of ovulation (egg production) and of menstruation (discharge of blood and tissue from the uterus). This process usually occurs between the ages of 45 and 55, the average age being 52 years.

The term “menopause” usually refers to a period of physical and psychological changes that occur as a result of reduced oestrogen production. The menopause usually occurs gradually; it is signalled by a change in menstrual patterns (perimenopause) followed by amenorrhoea (the cessation of menstrual periods). It can also be brought on by medical procedures that halt the activity of the ovaries, such as oophorectomy (surgical removal of the ovaries), radiotherapy, or chemotherapy. In a few women, the menopause may occur abnormally early, usually before age 40 (premature menopause).

Symptoms

Some women have few difficulties with the menopause. Other women may have symptoms including hot flushes and night sweats; vaginal dryness caused by thinning of the vaginal lining; and a decrease in vaginal secretions. The tissues in the neck of the bladder and the urethra also become thinner, which can cause a feeling of needing to urinate frequently. In addition, the breasts tend to decrease in size. Some women experience psychological symptoms, such as poor concentration, tearfulness, loss of interest in sex, and depression.

Changes in metabolism occur during the menopause but they may not cause symptoms until later. In all women, the bones become thinner; this process happens most rapidly in the years immediately after the menopause. The loss of bone density may result in osteoporosis. The risk of heart disease also increases, gradually approaching that for men of a similar age, due to the drastic reduction in oestrogen hormones (which protect premenopausal women against heart disease).

Treatment

Women going through the menopause can protect themselves from losing bone density by regularly taking weight-bearing exercise, such as walking, and by eating foods that are rich in calcium, such as dairy products and green, leafy vegetables. Measures such as avoiding fatty foods, stopping smoking, and limiting alcohol intake can help to protect women against heart disease.

Hormone replacement therapy (HRT) may relieve menopausal symptoms and reduce the risk of fractures associated with osteoporosis. However, it is not usually recommended as the first line of treatment because it may increase the risk of abnormal blood clotting and is associated with an increased risk of breast cancer.